Gram-positive Gram-negative Anaerobes Atypicals

Strep Staph Enterococcus

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penicillin G, penicillin VK      ±         
ampicillin, amoxicillin         ±      

Disclaimer: This table is a teaching and learning tool and is not meant to be comprehensive. Please use clinical judgment and
other references for clinical decision-making. Thanks to the following individuals for their input: Roxane Carr, Tila Pelletier,
Penicillins amoxicillin/clavulanate          ±     
cloxacillin ±              
piperacillin/tazobactam              1 
1st cephalexin, cefazolin        ± ±      
2nd cefuroxime, cefprozil         ±      
Cephalosporins 3rd ceftriaxone, cefotaxime          ±2    1 
3rd ceftazidime ± ±        2  2
  1 
4th cefepime          2 2   1 
ertapenem          3    1 
Carbapenems
imipenem, meropenem      4        1 
Other "Gram- vancomycin              5 
positive" agents linezolid, daptomycin               
ciprofloxacin   ±6   ±        1 
Quinolones levofloxacin      ±        1 
moxifloxacin      ±       ± 1 
Aminoglycosides gentamicin, tobramycin   SYN SYN SYN SYN SYN        

Cesilia Nishi, Tim Lau. Last updated August 2013 by Charles Au.
Polymyxins colistin          7     
Sulfonamides co-trimoxazole (TMP-SMX) ± ±  CA() ±     ±     
erythromycin ± ± ±            
Macrolides
clarithromycin, azithromycin  ±             
Lincosamides clindamycin    CA(±)         ± 1 
Tetracyclines tetracycline, doxycycline  ±  CA()    ± ±   8 8  
and derivatives tigecycline               
Nitroimidazoles metronidazole               

Legend and Ackronyms: Notes:

CA: May be effective for community-acquired MRSA
SYN: Synergy (combine with another agent)
CoNS: Coagulase-negative Staphylococcus
MSSA: Methicillin-sensitive Staph aureus
MRSA: Methicillin-resistant Staph aureus
"SPACE" bugs: Serratia, P. vulgaris, Providencia, Morganella,
Acinetobacter, Citrobacter, Enterobacter
1. These broad-spectrum antibiotics are associated with increased risk of C. difficile infection.
2. Avoid using as monotherapy due to inducible resistance in these bacteria.
3. Ertapenem does not cover Acinetobacter .
4. The activity of meropenem against Enterococcus is unclear. Formal susceptibility breakpoints are not available.
5. Only enteral (PO or PR) vancomycin (not IV) is effective against C. difficile infection.
6. Requires double coverage with another agent, as resistance can develop rapidly.
7. Colistin does not cover Proteus or Serratia .
8. Doxycycline has some anaerobic activity.